Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Computed tomography scanning and delirium in elder patients.
1) To examine the ordering of head CT scans in elder patients with delirium and cognitive impairment; and 2) to report CT scan findings associated with these conditions. ⋯ Considerable variability in ED CT scan ordering exists for elder patients with neurologic findings. Impaired consciousness and/or new focal neurologic signs are associated with acute findings on CT scan in elder patients. Acute CT abnormalities are uncommon in elder ED patients with other neurologic findings. Additional prospective evaluation is warranted prior to guideline development for CT scans in this patient population.
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To determine whether telephone preauthorization for reimbursement of ED care (medical "gate-keeping") by managed care organizations (MCOs) is associated with adverse outcomes. ⋯ Adverse outcomes occur with MCO gatekeeping, Although the present study cannot ascertain whether this is a frequent event or a rare one, the safety of MCO gatekeeping deserves further study.
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To characterize ambulance utilization in a pediatric population and pediatric emergency physicians' judgement of the medical need for ambulance transport. ⋯ Most pediatric ambulance transports in this sample, which excluded patients requiring immediate resuscitation or trauma team care, were judged to be medically unnecessary. Caregivers often use an ambulance as a convenience or as the only means of transportation. An alternate, less resource-intensive transportation system may be more appropriate for this population.
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To determine the optimal initial depth of tube placement in nasotracheal intubation (NTI) of adult patients, measured at the naris, prior to obtaining a chest radiograph (CXR). ⋯ Initial placement of NTI at 26 cm in women and 28 cm in men, measured at the naris, resulted in adequate initial placement for most adult patients.